Atrial septostomy can be used in the management of pulmonary hypertension that is resulting in severe issues with low heart output due to very high pressures in the right half of the heart.

This includes patients with heart failure causing severe difficulty with activity tolerance despite medications for PH or patients with syncope (passing out) episodes. This procedure is often performed in infants or young children with certain congenital heart defects.

The creation of a hole in the upper chambers will cause some blood to flow from the right half of the heart to be pumped out into the rest of the body. While this procedure allows for the needed heart output for organ function, the blood will contain less oxygen, causing patients to have oxygen saturations 5-10% lower than normal.

About the procedure

Atrial septostomy is usually performed in experienced cardiac care centers by cardiac catheterization though it can be done surgically as well.

Using a catheter, a cardiologist can puncture a small hole in the atrial septum and then enlarge the hole with a balloon to allow improved flow across it. Sometimes the cardiologist may place a stent in the hole to prevent it from closing.

After the atrial septostomy, studies have shown that patients tend to feel better overall with improved activity tolerance and a lower risk of syncope or fainting. This procedure can delay the need for a lung transplant. Individuals who undergo an atrial septostomy need close follow up and may need additional procedures including re-dilation of the atrial shunt.